Florida Senate - 2012                CS for CS for CS for SB 694
       
       
       
       By the Committees on Budget Subcommittee on Health and Human
       Services Appropriations; Health Regulation; and Children,
       Families, and Elder Affairs; and Senators Fasano, Haridopolos,
       Norman, Sachs, Gaetz, Bullard, Garcia, and Dockery
       
       603-03208-12                                           2012694c3
    1                        A bill to be entitled                      
    2         An act relating to adult day care centers; amending s.
    3         429.917, F.S.; prohibiting an adult day care center
    4         from claiming to be licensed or designated as a
    5         specialized Alzheimer’s services adult day care center
    6         under certain circumstances; creating s. 429.918,
    7         F.S.; providing a short title; providing definitions;
    8         providing for the licensure designation of adult day
    9         care centers that provide specialized Alzheimer’s
   10         services by the Agency for Health Care Administration;
   11         providing for the denial or revocation of such
   12         designation under certain circumstances; requiring an
   13         adult day care center seeking such designation to meet
   14         specified criteria; providing educational and
   15         experience requirements for the operator of an adult
   16         day care center seeking licensure designation as a
   17         specialized Alzheimer’s services adult day care
   18         center; providing criteria for staff training and
   19         supervision; requiring the Department of Elderly
   20         Affairs to approve the staff training; requiring the
   21         department to adopt rules; requiring that the employee
   22         be issued a certificate upon completion of the staff
   23         training; providing requirements for staff
   24         orientation; providing requirements for admission into
   25         such an adult day care center; requiring that a
   26         participant’s file include a data sheet, which shall
   27         be completed within a certain timeframe; requiring
   28         that certain information be included in the data
   29         sheet; requiring that dementia-specific services be
   30         documented in a participant’s file; requiring that a
   31         participant’s plan of care be reviewed quarterly;
   32         requiring that certain notes be entered into a
   33         participant’s file; requiring the participant, or
   34         caregiver, to provide the adult day care center with
   35         updated medical documentation; requiring the center to
   36         give each person who enrolls as a participant, or the
   37         caregiver, a copy of the participant’s plan of care
   38         and safety information; requiring that the center
   39         coordinate and execute discharge procedures with a
   40         participant who has a documented diagnosis of
   41         Alzheimer’s disease or a dementia-related disorder and
   42         the caregiver if the participant’s enrollment in the
   43         center is involuntarily terminated; providing that the
   44         act does not prohibit a licensed adult day care center
   45         that does not receive such a designation from
   46         providing adult day care services to persons who have
   47         Alzheimer’s disease or other dementia-related
   48         disorders; authorizing the Department of Elderly
   49         Affairs to adopt rules; providing an effective date.
   50  
   51  Be It Enacted by the Legislature of the State of Florida:
   52  
   53         Section 1. Subsection (2) of section 429.917, Florida
   54  Statutes, is amended to read:
   55         429.917 Patients with Alzheimer’s disease or other related
   56  disorders; staff training requirements; certain disclosures.—
   57         (2) A center licensed under this part which claims that it
   58  provides special care for persons who have Alzheimer’s disease
   59  or other related disorders must disclose in its advertisements
   60  or in a separate document those services that distinguish the
   61  care as being especially applicable to, or suitable for, such
   62  persons. The center must give a copy of all such advertisements
   63  or a copy of the document to each person who requests
   64  information about the center and must maintain a copy of all
   65  such advertisements and documents in its records. The agency
   66  shall examine all such advertisements and documents in the
   67  center’s records as part of the license renewal procedure. An
   68  adult day care center may not claim to be licensed or designated
   69  to provide specialized Alzheimer’s services unless the adult day
   70  care center’s license has been designated as such pursuant to s.
   71  429.918.
   72         Section 2. Section 429.918, Florida Statutes, is created to
   73  read:
   74         429.918Licensure designation as a specialized Alzheimer’s
   75  services adult day care center.—
   76         (1) This act may be cited as the “Josephine Corcoran
   77  Specialized Alzheimer’s Services Adult Day Care Act.”
   78         (2) As used in this section, the term:
   79         (a) “ADRD participant” means a participant who has a
   80  documented diagnosis of Alzheimer’s disease or a dementia
   81  related disorder (ADRD) from a licensed physician, licensed
   82  physician assistant, or a licensed advanced registered nurse
   83  practitioner.
   84         (b) “Dementia” means the loss of at least two intellectual
   85  functions, such as thinking, remembering, and reasoning, which
   86  is severe enough to interfere with a person’s daily function.
   87  The term does not describe a disease, but describes a group of
   88  symptoms that may accompany certain diseases or physical
   89  conditions.
   90         (c) “Specialized Alzheimer’s services” means therapeutic,
   91  behavioral, health, safety, and security interventions; clinical
   92  care; support services; and educational services that are
   93  customized for the specialized needs of a participant’s
   94  caregiver and the participant who is affected by Alzheimer’s
   95  disease or an irreversible, degenerative condition resulting in
   96  dementia.
   97         (d)“Therapeutic activity” means an individual or group
   98  activity that is intended to promote, maintain, or enhance the
   99  ADRD participant’s physical, cognitive, social, spiritual, or
  100  emotional health.
  101         (3) An adult day care center may apply to the agency to
  102  have its license issued under s. 429.907, designated as a
  103  “specialized Alzheimer’s services adult day care center,” if the
  104  requirements under this section have been met.
  105         (a)The adult day care center must notify the agency at
  106  least 30 days prior to initial licensure under s. 429.907 or, if
  107  already licensed, at least 6 months prior to the expiration of a
  108  license issued under s. 429.907, that the adult day care center
  109  is seeking a designation as a specialized Alzheimer’s services
  110  adult day care center.
  111         (b)The agency, after receiving the notification pursuant
  112  to paragraph (a), may make a determination at an initial
  113  licensure inspection or at a licensure renewal inspection as to
  114  whether the adult day care center meets the requirements of this
  115  section to be designated as a specialized Alzheimer’s services
  116  adult day care center. If the agency determines that the adult
  117  day care center meets the requirements of this section it must
  118  designate the adult day care center as a specialized Alzheimer’s
  119  services adult day care center at the time of initial licensure
  120  or at licensure renewal.
  121         (c)If the agency, during the initial or renewal
  122  inspection, determines that the adult day care center has
  123  committed an act under s. 429.911(2), the agency may deny the
  124  request for the designation or revoke such designation.
  125         (d)The agency may at any time revoke the designation if
  126  the adult day care center fails to maintain the requirements
  127  under this section.
  128         (4) To obtain or maintain the designation under this
  129  section, an adult day care center must:
  130         (a) Have a mission statement that includes a commitment to
  131  providing dementia-specific services and disclose in the
  132  center’s advertisements or in a separate document, which must be
  133  made available to the public upon request, the services that
  134  distinguish the care as being suitable for a person who has
  135  Alzheimer’s disease or a dementia-related disorder.
  136         (b) Provide ADRD participants with a program for dementia
  137  specific, therapeutic activities, including, but not limited to,
  138  physical, cognitive, and social activities appropriate for the
  139  ADRD participant’s age, culture, and level of function.
  140         (c) Maintain at all times a minimum staff-to-participant
  141  ratio of one staff member who provides direct services for every
  142  five ADRD participants.
  143         (d) Provide ADRD participants with a program for
  144  therapeutic activity at least 70 percent of the time that the
  145  center is open.
  146         (e) Provide ADRD participants with hands-on assistance with
  147  activities of daily living, inclusive of the provision of
  148  urinary and bowel incontinence care.
  149         (f) Use assessment tools that identify the ADRD
  150  participant’s cognitive deficits and identify the specialized
  151  and individualized needs of the ADRD participant and the
  152  caregiver. This assessment shall be conducted when the ADRD
  153  participant is initially admitted into the center and shall be
  154  updated when the ADRD participant experiences a significant
  155  change, but no less frequently than annually.
  156         (g) Create an individualized plan of care for each ADRD
  157  participant which addresses the identified, dementia-specific
  158  needs of the ADRD participant and the caregiver. The plan of
  159  care shall be established when the ADRD participant is initially
  160  admitted into the center and reviewed at least quarterly.
  161         (h) Conduct a monthly health assessment of each ADRD
  162  participant which includes, but is not limited to, the ADRD
  163  participant’s weight, vital signs, and level of assistance
  164  needed with activities of daily living.
  165         (i) Complete a monthly update in each ADRD participant’s
  166  file regarding the ADRD participant’s status or progress toward
  167  meeting the goals indicated on the individualized plan of care.
  168         (j) Assist in the referral or coordination of other
  169  dementia-specific services and resources needed by the ADRD
  170  participant or the caregiver, such as medical services,
  171  counseling, medical planning, legal planning, financial
  172  planning, safety and security planning, disaster planning,
  173  driving assessment, transportation coordination, or wandering
  174  prevention.
  175         (k) Offer, facilitate, or provide referrals to a support
  176  group for persons who are caregivers to ADRD participants.
  177         (l) Provide dementia-specific educational materials
  178  regularly to ADRD participants, as appropriate, and their
  179  caregivers.
  180         (m) Routinely conduct and document a count of all ADRD
  181  participants present in the center throughout each day. This
  182  count must be compared to each ADRD participant’s attendance
  183  record in order to ensure that an ADRD participant is not
  184  missing from the center.
  185         (n) Be a secured unit or have working alarm or security
  186  devices installed on every door that is accessible to the ADRD
  187  participant and provides egress from the center or areas of the
  188  center designated for the provision of adult day care -
  189  specialized Alzheimer’s services.
  190         (o) Not allow an ADRD participant to administer his or her
  191  own medication.
  192         (p)Condition the ADRD participant’s eligibility for
  193  admission on whether the ADRD participant has a coordinated mode
  194  of transportation to and from the adult day care center, to
  195  ensure that the participant does not drive to or from the
  196  center.
  197         (5)(a)The operator of an adult day care center having a
  198  license designated under this section, and the operator’s
  199  designee, as applicable, hired on or after July 1, 2012, shall:
  200         1. Have at least a bachelor’s degree in health care
  201  services, social services, or a related field, 1 year of staff
  202  supervisory experience in a social services or health care
  203  services setting, and a minimum of 1 year of experience in
  204  providing services to persons who have dementia;
  205         2. Be a registered or practical nurse licensed in this
  206  state, have 1 year of staff supervisory experience in a social
  207  services or health care services setting, and have a minimum of
  208  1 year of experience in providing services to persons who have
  209  dementia; or
  210         3. Have 5 years of staff supervisory experience in a social
  211  services or health care services setting and a minimum of 3
  212  years of experience in providing services to persons who have
  213  dementia.
  214         (b)The owner must sign an affidavit under penalty of
  215  perjury stating that he or she has verified that the operator,
  216  and the operator’s designee, if any, has completed the education
  217  and experience requirements of this subsection.
  218         (6)(a) An adult day care center having a license designated
  219  under this section must provide the following staff training and
  220  supervision:
  221         1. A registered nurse or licensed practical nurse must be
  222  on site daily for at least 75 percent of the time that the
  223  center is open to ADRD participants. Each licensed practical
  224  nurse who works at the center must be supervised in accordance
  225  with chapter 464.
  226         2. Upon beginning employment with the center, each employee
  227  must receive and review basic written information about
  228  interacting with ADRD participants.
  229         3. In addition to the information provided in subparagraph
  230  2., every employee hired on or after July 1, 2012, who has
  231  direct contact with ADRD participants shall complete 4 hours of
  232  dementia-specific training within 3 months after employment.
  233         4. In addition to the requirements of subparagraphs 2. and
  234  3., each employee hired on or after July 1, 2012, who provides
  235  direct care to ADRD participants shall complete an additional 4
  236  hours of dementia-specific training within 6 months after
  237  employment.
  238         (b) The Department of Elderly Affairs or its designee shall
  239  approve the training required under this section. The department
  240  shall adopt rules to establish standards for employees who are
  241  subject to this training, for trainers, and for the training
  242  required in this section.
  243         (c) Upon completing any training described in this section,
  244  the employee shall be issued a certificate that includes the
  245  name of the training provider, the topics covered, and the date
  246  and signature of the training provider. The certificate is
  247  evidence of completion of training in the identified topics, and
  248  the employee is not required to repeat training in those topics
  249  if the employee changes employment to a different adult day care
  250  center.
  251         (d) Each employee hired on or after July 1, 2012, who
  252  provides direct care to ADRD participants, must receive and
  253  review an orientation plan that includes, at a minimum:
  254         1. Procedures to locate an ADRD participant who has
  255  wandered from the center. These procedures shall be reviewed
  256  regularly with all direct care staff.
  257         2. Information on the Silver Alert program in this state.
  258         3. Information regarding available products or programs
  259  used to identify ADRD participants or prevent them from
  260  wandering away from the center, their home, or other locations.
  261         (7)(a) An ADRD participant admitted to an adult day care
  262  center having a license designated under this section, or the
  263  caregiver when applicable, must:
  264         1. Require ongoing supervision to maintain the highest
  265  level of medical or custodial functioning and have a
  266  demonstrated need for a responsible party to oversee his or her
  267  care.
  268         2. Not actively demonstrate aggressive behavior that places
  269  himself, herself, or others at risk of harm.
  270         3. Provide the following medical documentation signed by a
  271  licensed physician, licensed physician assistant, or a licensed
  272  advanced registered nurse practitioner:
  273         a. Any physical, health, or emotional conditions that
  274  require medical care.
  275         b. A listing of the ADRD participant’s current prescribed
  276  and over-the-counter medications and dosages, diet restrictions,
  277  mobility restrictions, and other physical limitations.
  278         4. Provide documentation signed by a health care provider
  279  licensed in this state which indicates that the ADRD participant
  280  is free of the communicable form of tuberculosis and free of
  281  signs and symptoms of other communicable diseases.
  282         (b) Before admitting an ADRD participant to an adult day
  283  care center that has a license designated under this section,
  284  the center shall determine whether:
  285         1. The medical, psychological, safety, and behavioral
  286  support and intervention required by the ADRD participant can be
  287  provided by the center.
  288         2. The resources required to assist with the ADRD
  289  participant’s acuity level of care and support needed can be
  290  provided or coordinated by the center.
  291         (8)(a) An ADRD participant’s file must include a data
  292  sheet, which must be completed within 45 days before or within
  293  24 hours after admission to an adult day care center having a
  294  license designated under this section. The data sheet must
  295  contain:
  296         1. Information regarding the status of the ADRD
  297  participant’s enrollment in an identification or wandering
  298  prevention program, including the name of the program; and
  299         2. A current photograph of the ADRD participant.
  300         (b) Dementia-specific services shall be documented in the
  301  ADRD participant’s file.
  302         (c) Notes regarding services provided to the ADRD
  303  participant must be entered at least monthly in the ADRD
  304  participant’s file, and must indicate the ADRD participant’s
  305  status or progress toward achieving identified goals. Additional
  306  notes must be entered more frequently if indicated by the ADRD
  307  participant’s condition.
  308         (d) An ADRD participant, or the participant’s caregiver,
  309  shall annually provide the center with updated medical
  310  documentation required under subparagraphs (7)(a)3. and 4., and
  311  the center must place that documentation in the ADRD
  312  participant’s file.
  313         (9) An adult day care center having a license designated
  314  under this section must give to each person who enrolls as an
  315  ADRD participant in the center, or the caregiver, a copy of the
  316  ADRD participant’s plan of care, as well as information
  317  regarding resources to assist in ensuring the safety and
  318  security of the ADRD participant, which must include, but need
  319  not be limited to, information pertaining to driving for those
  320  persons affected by dementia, available technology on wandering
  321  prevention devices and identification devices, the Silver Alert
  322  program in this state, and dementia-specific safety
  323  interventions and strategies that can be used in the home
  324  setting.
  325         (10) If an ADRD participant’s enrollment in the center is
  326  involuntarily terminated due to medical or behavioral reasons,
  327  the center shall coordinate and execute appropriate discharge
  328  procedures, to be determined by rule, with the ADRD participant
  329  and the caregiver.
  330         (11) This section does not prohibit an adult day care
  331  center that is licensed pursuant to s. 429.907, and without a
  332  designation under this section, from providing adult day care
  333  services to persons who have Alzheimer’s disease or other
  334  dementia-related disorders.
  335         (12) The Department of Elderly Affairs may adopt rules to
  336  administer this section.
  337         Section 3. This act shall take effect July 1, 2012.